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Endoscopic Ultrasound 2020ERCP is the current procedure of choice for patients with jaundice caused by biliary obstruction. EUS-guided biliary drainage (EUS-BD) has emerged as an alternative to... (Review)
Review
ERCP is the current procedure of choice for patients with jaundice caused by biliary obstruction. EUS-guided biliary drainage (EUS-BD) has emerged as an alternative to ERCP in patients requiring biliary drainage. The aim of the study was to conduct a systematic review and meta-analysis to report the overall efficacy and safety of EUS-BD. We conducted a comprehensive search of several databases including PubMed, EMBASE, Web of Science, Google Scholar, and LILACS databases (earliest inception to June 2018) to identify studies that reported EUS-BD in patients. The primary outcome was to look at the technical and clinical success of the procedure. The secondary analysis focused on calculating the pooled rate of re-interventions and all adverse-events, along with the commonly reported adverse-event subtypes. Twenty-three studies reporting on 1437 patients were identified undergoing 1444 procedures. Majority of the patient population were male (53.86%), with an average age of 67.22 years. The pooled technical success rates and clinical success rates were 91.5% (95% confidence interval [CI]: 87.7-94.2, I = 76.5) and 87% (95% CI: 82.3-90.6, I = 72.4), respectively. The total adverse event rates were 17.9% (95% CI: 14.3-22.2, I = 69.1). Subgroup analysis of three major individual adverse events was bile leak: 4.1% (2.7-6.2, I = 46.7), stent migration: 3.9% (2.5-6.2, I = 43.5), and infection: 3.8% (2.8-5.1, I = 0) Substantial heterogeneity was noted in the analysis. EUS-BD has high technical and clinical success rate and hence a very effective procedure. Concerns about publication bias exist. Careful consideration should be given to the adverse events and weighing the risks and benefits of the alternative nonsurgical/surgical approaches.
PubMed: 32295967
DOI: 10.4103/eus.eus_80_19 -
BMJ Paediatrics Open 2017To assess the global burden of late and/or poor management of severe neonatal jaundice (SNJ), a common problem worldwide, which may result in death or irreversible brain...
CONTEXT
To assess the global burden of late and/or poor management of severe neonatal jaundice (SNJ), a common problem worldwide, which may result in death or irreversible brain damage with disabilities in survivors. Population-based data establishing the global burden of SNJ has not been previously reported.
OBJECTIVE
Determine the burden of SNJ in all WHO regions, as defined by clinical jaundice associated with clinical outcomes including acute bilirubin encephalopathy/kernicterus and/or exchange transfusion (ET) and/or jaundice-related death.
DATA SOURCES
PubMed, Scopus and other health databases were searched, without language restrictions, from 1990 to 2017 for studies reporting the incidence of SNJ.
STUDY SELECTION/DATA EXTRACTION
Stratification was performed for WHO regions and results were pooled using random effects model and meta-regression.
RESULTS
Of 416 articles including at least one marker of SNJ, only 21 reported estimates from population-based studies, with 76% (16/21) of them conducted in high-income countries. The African region has the highest incidence of SNJ per 10 000 live births at 667.8 (95% CI 603.4 to 738.5), followed by Southeast Asian, Eastern Mediterranean, Western Pacific, Americas and European regions at 251.3 (132.0 to 473.2), 165.7 (114.6 to 238.9), 9.4 (0.1 to 755.9), 4.4 (1.8 to 10.5) and 3.7 (1.7 to 8.0), respectively. The incidence of ET per 10 000 live births was significantly higher for Africa and Southeast Asian regions at 186.5 (153.2 to 226.8) and 107.1 (102.0 to 112.5) and lower in Eastern Mediterranean (17.8 (5.7 to 54.9)), Americas (0.38 (0.21 to 0.67)), European (0.35 (0.20 to 0.60)) and Western Pacific regions (0.19 (0.12 to 0.31). Only 2 studies provided estimates of clear jaundice-related deaths in infants with significant jaundice [UK (2.8%) and India (30.8%).
CONCLUSIONS
Limited but compelling evidence demonstrates that SNJ is associated with a significant health burden especially in low-income and middle-income countries.
PubMed: 29637134
DOI: 10.1136/bmjpo-2017-000105 -
Journal of Clinical Gastroenterology Jan 2022We aimed to extract the percent of signs and symptoms at the time of diagnosis from published studies and to pool these using meta-analytic techniques.
GOAL
We aimed to extract the percent of signs and symptoms at the time of diagnosis from published studies and to pool these using meta-analytic techniques.
BACKGROUND
Delayed or misdiagnosis of chronic pancreatitis may occur because the signs and symptoms are nonspecific and varied.
STUDY
We performed a systematic review of studies reporting the signs and symptoms of chronic pancreatitis at diagnosis. The percentage of patients with each sign and symptom was extracted and random-effects meta-analyses used to calculate pooled percentages.
RESULTS
In total, 22 observational studies were included. Across 14 studies, 55% of chronic pancreatitis patients were classified as having alcoholic etiology. Abdominal pain was the most common symptom (76%), and weight loss was reported in 22% of patients. Jaundice occurred in 11% of patients and steatorrhoea in 3%. Half of the patients had a history of acute pancreatitis, and 28% had diabetes mellitus at diagnosis. Heterogeneity between the studies was high for all signs and symptoms.
CONCLUSIONS
This research has identified some common features of patients with chronic pancreatitis, but the high heterogeneity makes it difficult to draw solid conclusions. Carefully designed studies to examine the signs and symptoms leading up to a diagnosis of chronic pancreatitis, and common combinations, are required. These would enable the development of a tool to aid in the early identification of chronic pancreatitis in the primary care setting, with potential for improved short-term and long-term outcomes for patients.
Topics: Acute Disease; Humans; Pancreatitis, Chronic; Primary Health Care; Prodromal Symptoms
PubMed: 34049375
DOI: 10.1097/MCG.0000000000001544 -
Steroids after the Kasai procedure for biliary atresia: the effect of age at Kasai portoenterostomy.Pediatric Surgery International Mar 2016The use of adjuvant steroids following Kasai porteoenterostomy (KPE) for biliary atresia is controversial. The aim of this study was twofold: a systematic review of... (Review)
Review
The use of adjuvant steroids following Kasai porteoenterostomy (KPE) for biliary atresia is controversial. The aim of this study was twofold: a systematic review of published literature and an update of the clinical Kings College Hospital series to look for evidence of an effect of age on the outcome in a group of BA infants treated with high-dose steroids. This clinical study included infants treated between January 2006 and June 2014 who underwent KPE by day 70 of life and who received high-dose steroids (oral prednisolone starting 5 mg/kg/day). They were subdivided into cohorts according to age at which KPE was performed. The outcome measured was clearance of jaundice (<20 µmol/L) by 6 months and native liver survival. R × C χ(2) analysis and log-rank tests were used, respectively, and P ≤ 0.05 was regarded as significant. 104 infants were included with a median age at KPE of 45 (range 12-70) days. 71/104 (67 %) cleared their jaundice by 6 months of age. Age-cohort analysis showed a trend (P = 0.03) favouring early KPE (e.g. 100 % of 11 infants operated on <30 days clearing their jaundice compared to 66 % of those operated on between 61 and 70 days). There was a significant native liver survival benefit for those operated on <45 days (5 year NLS estimate 69 versus 46 %; P = 0.05). Clearance of jaundice is related to the age at KPE in infants who receive high-dose steroids. Native liver survival appears to be improved as a result of this. This is the first study to show tangible longer-term benefit from high-dose steroids in biliary atresia.
Topics: Age Factors; Biliary Atresia; Cholangitis; Glucocorticoids; Humans; Infant; Infant, Newborn; Liver; Portoenterostomy, Hepatic; Postoperative Complications; Prednisolone
PubMed: 26590818
DOI: 10.1007/s00383-015-3836-3 -
Digestion 2023At present, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangial drainage (PTCD) are frequently used for reducing malignant... (Meta-Analysis)
Meta-Analysis
Comparison of Efficacy and Safety between Endoscopic Retrograde Cholangiopancreatography and Percutaneous Transhepatic Cholangial Drainage for the Treatment of Malignant Obstructive Jaundice: A Systematic Review and Meta-Analysis.
BACKGROUND
At present, endoscopic retrograde cholangiopancreatography (ERCP) and percutaneous transhepatic cholangial drainage (PTCD) are frequently used for reducing malignant obstructive jaundice (MOJ). However, it is controversial as to which method is superior in terms of efficacy and safety.
OBJECTIVES
The aim of this study was to compare the safety, feasibility, and clinical benefits of ERCP and PTCD in matched cases of MOJ.
METHODS
The Web of Science, Cochrane, PubMed, and CNKI databases were searched systematically to identify studies published between January 2000 and December 2019, without language restrictions, that compared ERCP and PTCD in patients with MOJ. The primary outcome was the success rate for each procedure. The secondary outcomes were the technical success rate, serum total bilirubin level, length of hospital stay, hospital expense, complication rate, and survival. This meta-analysis was performed using Review Manager 5.3.
RESULTS
Sixteen studies met the inclusion criteria, including 1,143 cases of ERCP and 854 cases of PTCD. The analysis demonstrated that jaundice remission in PTCD was equal to that in ERCP (mean difference [MD], 1.19; 95% confidence interval [CI]: -0.56 to -2.93; p = 0.18). However, the length of hospital stay in the ERCP group was 3.03 days shorter than that in the PTCD group (MD, -2.41; 95% CI: -4.61 to -0.22; p = 0.03). ERCP had a lower rate of postoperative complications (odds ratio, 0.66; 95% CI: 0.42-1.05); however, the difference was not significant (p = 0.08). ERCP was also more cost-efficient (MD, -5.42; 95% CI: -5.52 to -5.32; p < 0.01). Further, we calculated the absolute mean of hospital stay (ERCP:PTCD = 8.73:12.95 days), hospital expenses (ERCP:PTCD = 5,104.13:5,866.75 RMB), and postoperative complications (ERCP:PTCD = 11.2%:9.1%) in both groups.
CONCLUSION
For remission of MOJ, PTCD and ERCP had similar clinical efficacy. Each method has its own strengths and weaknesses. Considering that ERCP had a lower rate of postoperative complications, shorter hospital stay, and higher cost efficiency, ERCP may be a superior initial treatment choice for MOJ.
Topics: Humans; Cholangiopancreatography, Endoscopic Retrograde; Jaundice, Obstructive; Drainage; Treatment Outcome; Postoperative Complications
PubMed: 36617409
DOI: 10.1159/000528020 -
The Journal of Maternal-fetal &... Dec 2022This systematic review and meta-analysis study aimed to estimate the overall prevalence of Glucose-6-phosphate dehydrogenase (G6PD) deficiency in neonates with jaundice... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
This systematic review and meta-analysis study aimed to estimate the overall prevalence of Glucose-6-phosphate dehydrogenase (G6PD) deficiency in neonates with jaundice who were admitted to hospitals in Iran.
MATERIALS AND METHODS
In this systematic review and meta-analysis, we searched PubMed/Medline, Scopus, ISI Web of Sciences, and Iranian Local databases up to December 2019.We calculated Prevalence and 95% Confidence Interval (95% CI) of G6PD deficiency as summary measures. We conducted subgroup analysis based on the sex and quality of studies, while meta-regression were applied for investigating the effect of years of studies and years of publication on the pooled prevalence. We applied sensitivity analysis to investigate the effect of excluding each study on the pooled prevalence estimation.
RESULTS
The total sample size was 9799 people. The pooled prevalence of G6PD deficiency among neonates with jaundice in Iran was 7.0% (95% CI: 5.5-8.5%). The results of subgroup analysis showed that, pooled prevalence of G6PD deficiency among male neonate (12.1%, 95%CI: 7.6-16.7%) was more prevalent that female (3.00%, 95%CI: 1.1-4.9%). Based on the sensitivity analysis, lower and higher pooled prevalence of G6PD deficiency was observed 5.8% (95%CI: 4.7-6.9%) and 7.3% (95%CI: 5.7-8.8%) respectively by excluding each study.
CONCLUSION
The overall prevalence of G6PD deficiency was 7% in Iranian neonates with Jaundice. Prevalence was high in male and early hours of life. We recommend screening test for G6PD deficiency in neonates to prevent its complications.
Topics: Female; Humans; Infant, Newborn; Male; Glucosephosphate Dehydrogenase; Glucosephosphate Dehydrogenase Deficiency; Iran; Jaundice, Neonatal; Prevalence
PubMed: 33722175
DOI: 10.1080/14767058.2021.1895738 -
Journal of Surgical Oncology Sep 2018Preoperative jaundice is considered a relative contraindication to radical gallbladder cancer (GBC) resection due to poor prognosis and high postoperative morbidity.... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Preoperative jaundice is considered a relative contraindication to radical gallbladder cancer (GBC) resection due to poor prognosis and high postoperative morbidity. Recent reports have indicated that aggressive surgery may improve long-term survival for patients with advanced GBC who present with obstructive jaundice. The current systematic review and meta-analysis aimed to compare postoperative outcomes among jaundiced and non-jaundiced patients with resectable GBC.
METHODS
An electronic search was performed using several Medical Subject Headings terms: cholecyst, gallbladder, tumor, cancer, carcinoma, adenocarcinoma, neoplasia, neoplasm, jaundice, and icterus. Overall survival after surgery was the primary outcome; resectability and postoperative morbidity were the secondary outcomes.
RESULTS
Overall survival was shorter among patients who presented with jaundice (Hazard ratio [HR]: 2.21, 95% confidence interval [CI], 1.64-2.97; P < 0.001). Patients with jaundice were less likely to have resectable disease (odds ratio: 0.27, 95% CI, 0.17-0.43; P < 0.001). The jaundice group had higher odds of postoperative morbidity, bile-leak, and posthepatectomy failure versus the non-jaundiced control group.
CONCLUSIONS
Radical surgery for GBC resection for patients presenting with obstructive jaundice was associated with reduced overall survival and increased postoperative morbidity. Jaundiced patients with advanced GBC should be considered for surgical resection but need careful evaluation and counseling before undertaking extensive surgical resection.
Topics: Bile Duct Neoplasms; Gallbladder Neoplasms; Hepatectomy; Humans; Jaundice; Prognosis; Survival Rate
PubMed: 30259519
DOI: 10.1002/jso.25186 -
Neurosurgical Focus Oct 2019Myelomeningocele (MMC), the most severe form of spina bifida, is characterized by protrusion of the meninges and spinal cord through a defect in the vertebral arches.... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Myelomeningocele (MMC), the most severe form of spina bifida, is characterized by protrusion of the meninges and spinal cord through a defect in the vertebral arches. The management and prevention of MMC-associated hydrocephalus has evolved since its initial introduction with regard to treatment of MMC defect, MMC-associated hydrocephalus treatment modality, and timing of hydrocephalus treatment.
METHODS
The Nationwide Inpatient Sample (NIS) database from the years 1998-2014 was reviewed and neonates with spina bifida and hydrocephalus status were identified. Timing of hydrocephalus treatment, delayed treatment (DT) versus simultaneous MMC repair with hydrocephalus treatment (ST), and treatment modality (ETV vs ventriculoperitoneal shunt [VPS]) were analyzed. Yearly trends were assessed with univariable logarithmic regression. Multivariable logistic regression identified correlates of inpatient shunt failure. A PRISMA systematic literature review was conducted that analyzed data from studies that investigated 1) MMC closure technique and hydrocephalus rate, 2) hydrocephalus treatment modality, and 3) timing of hydrocephalus treatment.
RESULTS
A weighted total of 10,627 inpatient MMC repairs were documented in the NIS, 8233 (77.5%) of which had documented hydrocephalus: 5876 (71.4%) were treated with VPS, 331 (4.0%) were treated with ETV, and 2026 (24.6%) remained untreated on initial inpatient stay. Treatment modality rates were stable over time; however, hydrocephalic patients in later years were less likely to receive hydrocephalus treatment during initial inpatient stay (odds ratio [OR] 0.974, p = 0.0331). The inpatient hydrocephalus treatment failure rate was higher for patients who received ETV treatment (17.5% ETV failure rate vs 7.9% VPS failure rate; p = 0.0028). Delayed hydrocephalus treatment was more prevalent in the later time period (77.9% vs 69.5%, p = 0.0287). Predictors of inpatient shunt failure included length of stay, shunt infection, jaundice, and delayed treatment. A longer time between operations increased the likelihood of inpatient shunt failure (OR 1.10, p < 0.0001). However, a meta-analysis of hydrocephalus timing studies revealed no difference between ST and DT with respect to shunt failure or infection rates.
CONCLUSIONS
From 1998 to 2014, hydrocephalus treatment has become more delayed and the number of hydrocephalic MMC patients not treated on initial inpatient stay has increased. Meta-analysis demonstrated that shunt malfunction and infection rates do not differ between delayed and simultaneous hydrocephalus treatment.
Topics: Female; Humans; Hydrocephalus; Infant, Newborn; Male; Meningomyelocele; Neuroendoscopy; Postoperative Complications; Third Ventricle; Treatment Failure; Treatment Outcome; Ventriculoperitoneal Shunt; Ventriculostomy
PubMed: 31574479
DOI: 10.3171/2019.7.FOCUS19469 -
The Journal of Maternal-fetal &... May 2018Zinc sulfate may be a promising approach to treat neonatal jaundice. However, the results remain controversial. We conducted a systematic review and meta-analysis to... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Zinc sulfate may be a promising approach to treat neonatal jaundice. However, the results remain controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of zinc sulfate on hyperbilirubinemia among neonates.
METHODS
PubMed, EMbase, Web of science, EBSCO, Cochrane library databases, Ovid, BMJ database, and CINAHL were systematically searched. Randomized controlled trials (RCTs) assessing the effect of zinc sulfate versus placebo on the prevention of jaundice in neonates were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. The primary outcomes were total serum bilirubin (TSB) on three days and seven days, the incidence of hyperbilirubinemia. Meta-analysis was performed using random- or fixed-effect models.
RESULTS
Five RCTs involving 645 patients were included in the meta-analysis. Overall, compared with placebo, zinc sulfate supplementation failed to significantly reduce TSB on three days (mean difference (MD) = 0.09 mg/dL; 95% confidence interval (CI) = -0.49 to 0.67; p = .77), TSB on seven days (MD = -0.37 mg/dL; 95% CI = -98 to 0.25; p = .25) as well as the incidence of hyperbilirubinemia (OR = 1.14; 95% CI = 0.74 to 1.76; p = .56). Zinc sulfate showed no influence on phototherapy requirement (OR = 0.90; 95% CI = 0.41 to 1.98; p = .79), but resulted in significantly decreased duration of phototherapy (MD = -16.69 h; 95% CI = -25.09 to -8.3 h; p < .0001).
CONCLUSIONS
Zinc sulfate could not reduce the TSB on three days and seven days, the incidence of hyperbilirubinemia and phototherapy requirement, but lead to significantly decreased duration of phototherapy.
Topics: Bilirubin; Dietary Supplements; Female; Gestational Age; Humans; Infant, Newborn; Jaundice, Neonatal; Male; Phototherapy; Randomized Controlled Trials as Topic; Time Factors; Zinc Sulfate
PubMed: 28372469
DOI: 10.1080/14767058.2017.1315659 -
Heliyon Jul 2023Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic disorder caused by a structural abnormality in the enzyme. G6PD deficiency is most prevalent among... (Review)
Review
BACKGROUND
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic disorder caused by a structural abnormality in the enzyme. G6PD deficiency is most prevalent among African, Asian, and Mediterranean people. This study aimed to investigate how prevalent G6PD deficiency is in African neonates with jaundice.
METHODS
The public sources, such as PubMed, Science Direct, Google Scholar, and Africa Journal Online were searched for articles that reported the prevalence of G6PD deficiency published before March 21st, 2022. The Joanna Briggs Institute's (JBI) critical assessment checklist was used to evaluate the quality of individual studies. STATA-17 was used to do the statistical analysis. The pooled prevalence of G6PD deficiency in neonates with jaundice in Africa was calculated using a forest plot and a random effects model. I statistics and Galbraith plots were used to assess heterogeneity. Publication bias was assessed using a funnel plot and Egger's statistical test.
RESULTS
Ten studies involving 1555 neonates with jaundice were involved in the study. G6PD deficiency was prevalent in 24.60% of African neonates with jaundice (95% CI:12.47-36.74) with considerable heterogeneity (I = 100%). Nigerian neonates with jaundice had the highest G6PD deficiency (49.67%), whereas South Africans had the lowest (3.14%).
CONCLUSION
G6PD deficiency has been implicated in a significant portion of African neonates with jaundice, notwithstanding the need for greater research on predisposing variables from other countries. Therefore, it should be thought of performing screening and diagnostic laboratory tests for G6PD deficiency.
PubMed: 37539282
DOI: 10.1016/j.heliyon.2023.e18437